Prudent use of antibiotics: are our expectations justified?

Prudent use of antibiotics has 3 components, rational use, adherence to local guidelines and policies, and avoidance or reversal of upward demographic trends in antibiotic resistance. Although rational use is mandatory, it must be recognized that adherence to policies will reduce clinical freedom, for good or ill. Expectations that prudent use will deliver reversals in resistance trends should be accepted with caution. Sound, pertinent data are lacking, and our ability to detect change, if it does occur, and to attribute its cause correctly, is questionable.